Chester M. Pierce, MD Division of Global Psychiatry, Department of Psychiatry, Massachusetts General Hospital (MGH), Center for Global Health, Room 1529-E3, 100 Cambridge Street, 15th floor, Boston, MA, 02114, USA,
AIDS Behav. 2013 Oct;17(8):2725-31. doi: 10.1007/s10461-013-0503-3.
Program implementers and qualitative researchers have described how increasing availability of HIV antiretroviral therapy (ART) is associated with improvements in psychosocial health and internalized stigma. To determine whether, and through what channels, ART reduces internalized stigma, we analyzed data from 262 HIV-infected, treatment-naïve persons in rural Uganda followed from ART initiation over a median of 3.4 years. We fitted Poisson regression models with cluster-correlated robust estimates of variance, specifying internalized stigma as the dependent variable, adjusting for time on treatment as well as socio-demographic, clinical, and psychosocial variables. Over time on treatment, internalized stigma declined steadily, with the largest decline observed during the first 2 years of treatment. This trend remained statistically significant after multivariable adjustment (χ(2) = 28.3; P = 0.03), and appeared to be driven by ART-induced improvements in HIV symptom burden, physical and psychological wellbeing, and depression symptom severity.
方案实施者和定性研究人员已经描述了 HIV 抗逆转录病毒疗法（ART）的可及性增加如何与心理社会健康和内化污名的改善相关。为了确定 ART 是否以及通过何种途径减少内化污名，我们分析了乌干达农村地区 262 名 HIV 感染、治疗初治的患者的数据，这些患者从 ART 开始接受中位数为 3.4 年的治疗。我们使用具有聚类相关稳健方差估计的泊松回归模型进行分析，将内化污名作为因变量，调整了治疗时间以及社会人口统计学、临床和心理社会变量。随着治疗时间的推移，内化污名稳步下降，在治疗的头 2 年观察到最大的下降。在多变量调整后，这种趋势仍然具有统计学意义（χ(2) = 28.3；P = 0.03），并且似乎是由 ART 引起的 HIV 症状负担、身体和心理健康以及抑郁症状严重程度的改善所驱动。
